Article excerpt

How to ensure that new programs and practices are spread and adopted.

Individuals across the world are using longer, mostly because of basic advances in public health such as sanitation and clean drinking water. In the United States, changes in lifestyle that include more health-promoting behavior are among the factors helping individuals to live longer. Because of the increasing numbers of people living longer, efforts to encourage such behavior requires a a shift from a focus on individuals in clinical settings to a focus on subpopulations within the community and society.

POPULATION HEALTH AND AGING

Two major developments in the twentieth century are important in a consideration of population health and aging. In health, the causes of population mortality shifted from acute, infectious diseases to chronic, noninfectious diseases. Thus, the basic public health notions of prevention have required revision. Although primary prevention avoids the pathological onset of disease, and secondary prevention delays the clinical onset of disease (German, 1995), the new prevalence of chronic conditions required a new emphasis on modifying health-related behaviors such as diet and exercise and screening for early detection of potential problems.

At the same time, the age distribution of the U.S. population has changed, with more individuals living longer, combined with decreasing fertility rates.

Combined, these epidemiological and demographic transitions present a significant challenge to those who wish to provide effective health promotion interventions. For example, the presence of existing diseases may distract healthcare providers and elders themselves from taking preventive measures (German, 1995). As more and more older adults live longer with chronic diseases, public health approaches mast go beyond the healthcare system to the community to prevent or delay chronic diseases.

The range of preventive health behaviors includes lifestyle practices such as exercise and eating habits as well as undergoing medically recommended procedures such as screening. Fifty percent of premature mortality is directly related to individual lifestyle factors and behaviors; a much lower percentage of premature mortality is related to genetic profiles or inadequate access to medical care (McLeroy and Crump, 1994). What is more, while preventive health behaviors play a substantial role in reducing the risk for premature death, the positive effects also reduce the risk for disability from chronic disease, even among older adults.

PROMOTING ADOPTION OF 'HEALTH BEHAVIORS'

What is the best means to promote adoption of these obviously valuable health behaviors given current population realities?

Traditionally, health educators have taken a "rational" model of behavior and decision making. According to that model, with the right information, elders will change their behaviors accordingly. Health education strategies from this standpoint, then, focus on the readability of health education materials, adding language and graphics to make material "culturally competent," and having the change agent be someone the target audience can identify with. While these are no doubt effective for some target audience members, the approach is incomplete in that it does not consider the larger social context of health behaviors.

The relational approach, on the other hand, adds perspective on the issue and inherently considers individuals and their reciprocal engagement within the larger social context (Green, 1984). That is, it is not just that the "change agent" is a credible source but that this person is well connected within the community and has influence over his or her peers. This situating of the change agent within the larger community in relation to others is directly in line with a public health perspective.

A RELATIONAL PERSPECTIVE

Public health researchers have increasingly begun to adopt a relational perspective on individuals' health behaviors and to study not just attributes of individuals but also their actual relations with other individuals with the underlying assumption that these relations influence their health behaviors. …